In abdominal surgery using laparoscopic techniques, the abdomen is initially penetrated with a needle, known as a Verres needle and carbon dioxide is utilized to extend the abdomen so that subsequent surgical steps can proceed.
The double-lumen Verres needle with its blunted spring-loaded mechanism is designed to allow a sharp penetration of the abdominal wall, yet protect the intra-abdominal viscera. It includes an outer sleeve with a sharp tip which harbors a blunt inner needle that is yieldingly urged outwardly of the outer sleeve by a spring. The manual pressure against the abdominal wall or peritoneum causes the blunt inner needle to retract, leaving the sharp outer sleeve unguarded to penetrate the abdominal layers. Once the resistance is overcome, the inner blunt needle springs out again, preventing any further damage to the intra-abdominal viscera by the sharp edge.
In many patients with strong abdominal tissues, greater force is required to penetrate the abdominal wall and the needle may be accidentally advanced deeper after its penetration of the peritoneum and may injure the bowel or major intra-abdominal vessels.
Injuries of the bowel and rarely of the major abdominal arteries or veins have been reported. Those injuries often required a major surgical exploration in order that they may be repaired and may even cause the death of patient if they go unnoticed.
To reduce the chance of injuries to the intra-abdominal organs, the abdominal wall is manually elevated by skin traction prior to manual insertion of the Verres needle. This elevation of the abdominal wall results in an increase of the distance of the abdominal wall from the major vessels and bowels. The insertion of the needle is facilitated by incising the skin with a scalpel to an opening of 3-4 mm.
The abdominal wall is elevated by grasping the peniculus with one hand or towel clips while the other hand directs the Verres needle at a right angle to the fascia and peritoneum and slowly penetrate the abdominal wall layers.
An experienced laparoscopist will notice a distinctive sensation when the needle transverses each of the layers of an abdominal wall and he will stop applying pressure after the needle has penetrated the peritoneum and he will be very cautious when piercing the peritoneum.
Among the objectives of the present invention are to provide an apparatus for holding the Verres needle and elevating the abdominal wall; which permits controlling the speed and force of insertion of the needle when piercing the abdominal wall; which can be sterilized and used repeatedly.
In accordance with the invention, an apparatus is provided for supporting a Verres needle which includes means for grasping a portion of the abdomen such that the needle may be moved to penetrate the abdomen to create a space between the abdominal wall and the abdominal organs and includes means for advancing the Verres needle toward the abdominal cavity by relative movement to the needle with respect to the portion of the apparatus which holds the needle. The apparatus further includes means for controlling the movement of the needle relative to the grasping portion of the apparatus.